Minorities born with heart defects at higher risk of dying in early childhood than whites

Tampa, FL (April 18, 2011) -- Non-Hispanic black infants born
with heart defects are more likely to die within the first five
years of life than their non-Hispanic white and Hispanic peers. For
certain types of congenital heart abnormalities, Hispanic children
as well as non-Hispanic black children fare worse than non-Hispanic
white children.

These findings, detailed in a new study by researchers at the
University of South Florida, Texas Department of State Health
Services and University of Texas Southwestern Medical Center,
suggest preventive strategies are needed to reduce racial and
ethnic disparities among infants and young children with heart
defects. The research is published online today in the journal
Pediatrics.

"When you consider that the numbers of minority children
continue to grow and are expected to account for more than half of
all U.S. children by 2040, it's clear we need to reduce the racial
and disparities that burden the health care system and adversely
affect the lives of families," said lead author Wendy Nembhard,
PhD, associate professor of epidemiology at the USF College of
Public Health.

Congenital heart defects are malformations in one or more
structures of the heart or major blood vessels that occur before
birth. They are the most common of all birth defects and the
leading cause of death among infants with birth defects.

The new study adds to a growing body of evidence that minority
infants with specific types of heart defects have poorer survival
rates in early childhood than non-Hispanic white infants.

The researchers retrospectively reviewed the records of 19,530
single infants born with congenital heart defects in Texas from
January 1996 through December 2005. The study was limited to
infants born to non-Hispanic white, non-Hispanic black and Hispanic
women. Linking records from the Texas Birth Defect Registry to
Texas death records and the National Death Index, the researchers
analyzed survival rates and risk of childhood death within the
first five years of life for each type of congenital heart
defect.

Among the study findings:

Non-Hispanic black race/ethnicity was more strongly associated
with increased risk of early childhood death than Hispanic
race/ethnicity.

Overall, non-Hispanic black infants with congenital heart
defects had a 32 percent greater risk of early childhood death than
their non-Hispanic white counterparts. In contrast, Hispanic
infants with heart defects had no overall increased risk of early
childhood death when compared with white infants.

The risk of early childhood death was twice as great for
non-Hispanic black infants with a reversal in primary connections
of the heart's two main blood vessels (known as transposition of
the great arteries) as for similarly affected non-Hispanic white
infants. The same two-fold increased risk was seen in this group
for tetralogy of Fallot, a cyanotic heart defect causing low oxygen
levels in the blood.

Of the three racial/ethnic groups, non-Hispanic black infants
consistently had the lowest survival rates for congenital
abnormalities in the septum (wall) separating the left and right
sides of the heart.

Hispanic children had the lowest survival rate of the three
groups for hypoplastic left heart syndrome, a rare defect in which
the heart's left side is critically underdeveloped. They were also
less like to survive than non-Hispanic whites when born with
pulmonary valve atresia without ventricular septic defect, a
condition including absence of the pulmonary valve opening in the
heart.

The researchers suggest the inequalities in early childhood
survival may be caused by several factors: underlying racial/ethnic
biological differences, including severity of the defect or the
number of co-occurring defects; lack of timely access to quality
health care; and cultural factors or preferences, such as
differences in prenatal diagnosis of defects.

Future studies should determine what role these factors and
others may play, so that effective public health policies can be
devised to improve the health of minority children born with heart
defects, the researchers conclude.